| NPI | 1497751580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD034985E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 251643471) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2021-03-10 |